Provider Demographics
NPI:1063564177
Name:OLALIA, SONNY (BSPT)
Entity type:Individual
Prefix:MR
First Name:SONNY
Middle Name:
Last Name:OLALIA
Suffix:
Gender:M
Credentials:BSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8829 54TH AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4543
Mailing Address - Country:US
Mailing Address - Phone:718-760-2312
Mailing Address - Fax:718-760-2312
Practice Address - Street 1:50 SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-2420
Practice Address - Country:US
Practice Address - Phone:718-345-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024152-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist